I interviewed today and was offered one of six resident positions. I lost it. The panel laughed and said my reaction was the best one so far. ?
I was asked nine questions. They were along the lines of "Tell me about yourself; How will you contribute to VA care; Flexibility and describe a time when it was required; Career goals; Rate yourself 0 - 10 in the following aspects, etc.". I was sweating the whole time, but displayed a cool (I think) exterior.
It starts towards the end of September, so plenty of time for me to go over all my material from school and beef up my knowledge so I don't look like a total dunce.
I will periodically update this thread with all my trials and tribulations for those who are interested in applying for a spot in the future and want to know what the year will look like.
Specializes in Former NP now Internal medicine PGY-3.
3 hours ago, momathoner09 said:
I started in the fall and am halfway through my second rotation. We rotate every 2 months for the first 6 months. The second 6 months we have specialty rotations (not quite sure how this is going to work honestly). Anyway at first it was a lot but I think I’ve found a rhythm. It’s as much or as little as you want to get out of it. I have really tried to do what I can a utilize all the resources that we have available. For our residency we are in lot of different clinics throughout the week. So right now I am in CLC, POSH, COACH, and Geri Pact clinic. For Geri pact we have a panel and we are the PCP. That for me has been the most work beyond that clinic appointment. Lots of f/us, consults, med refills, med changes, etc. But I feel like I have learned the most from that rotation.
LOL we have to do CLC for two weeks during our medical residency and all I can say is I’ve never been somewhere where they can turn a list of 12 nursing home patients into a full days worth of work.
I started in the fall and am halfway through my second rotation. We rotate every 2 months for the first 6 months. The second 6 months we have specialty rotations (not quite sure how this is going to work honestly). Anyway at first it was a lot but I think I’ve found a rhythm. It’s as much or as little as you want to get out of it. I have really tried to do what I can an utilize all the resources that we have available. For our residency we are in lot of different clinics throughout the week. So right now I am in CLC, POSH, COACH, and Geri Pact clinic. For Geri pact we have a panel and we are the PCP. That for me has been the most work beyond that clinic appointment. Lots of f/us, consults, med refills, med changes, etc. But I feel like I have learned the most from that rotation.
It definitely sounds they have you doing exactly what happens at a typical primary care appointment. That's excellent! Thank you so much for sharing. Best of luck to you!
Specializes in Former NP now Internal medicine PGY-3.
1 hour ago, Freckledkorican said:
Please, give me a few examples of the private hospital systems superiority. I will give you a few examples of what I've experienced so far during my VA residency and you tell me if the private sector does it better.
1. Each new patient is referred to whole health coaching. From what I've gathered, the veterans enjoy learning and applying different behavioral methods/modalities they've found useful for their life from the meetings. If needed, aromatherapy, battlefield acupuncture, aquatic therapy, music therapy, etc. may be added to enhance their care. All of this is at no extra cost to the veteran.
2. I have just about instant access to the pharmacist that works on my team. If I have a question or need advice, I can either walk down the hall to talk to them or message them. Also, each newly prescribed medication or renewal is vetted, meaning it will get kicked back if a pharmacist finds it is incorrect for whatever reason. They will deny it, tell you why, and give you recommendations and/or alternatives.
3. If I find that a veteran needs mental health (MH) intervention now rather than later, I can message the MH provider that a warm hand off is required. Once our visit has concluded, I walk the veteran to the MH provider and the veteran receives the care they need right then and there. Same goes for social work.
So far, I am impressed with the care the veterans receive at the VA. The veterans express their appreciation to me and are grateful we take such good care of them. My husband is a 100% disabled veteran and he has nothing but high praise for the VA. I haven't worked for the private sector, so please, enlighten us. I would love to attempt to address and rectify inefficiencies at the VA in order to improve patient care.
Okay I’ll type up some thoughts once on a computer and not phone. It is very VA dependent and I will say my experiences are from one of the better VAs. The patient care seems decent at the one I am am (did not mention anything about substandard patient care) but the complaints are moreso with working at the VA and the cost to achieve what the VA achieves. The amount of staff required to carry out something that usually gets done rather promptly in the community is mind boggling. But I will hash this out below. Experience comes from dealing w the VA for three years.
Specializes in Former NP now Internal medicine PGY-3.
Okay, this post is from a training standpoint, not a patient, or admin standpoint. The OP's post was revolving around residency at the VA so we will stick to this.
- onboarding: The amount of mostly pointless online (and unfortunately) in person training required for the VA is much higher than that of the private sector. Each year we have to do a bunch of modules which are mostly "duh" in quality. The first time onboarding we had to do CPRS training which was essentially an 8 hour session where someone "walks" us through online how to do things. Keep in mind we couldn't actually access CPRS for this training, you know "learn by doing" which pretty much every study shows is the best way to learn most things. Contrast to epic or cerner training where you do it in person or at least can access it via remote access.
- CPRS: This was probably a good system like 20 years ago, but for 2022 (really 2023) it is utter garbage. Is it the worst EMR? Maybe not, but it tries to be. No search function, no autocorrect, hard to read text, can be very slow for something that looks like it was made on a super nintendo. There is no recent patient list, difficult to read "flagging" of results, and don't get me started on the alerts. The system seems to think EVERYTHING needs to be sent to a mandatory "alert" box that you have to click and address. Some VAs have templates built in, but you may as well copy paste something from a word doc since they are slow, with tiny boxes, and often LAG like dial up did back in the 90s. Essentially have to have two monitors to write notes since you cannot really split screen things like you can on most highly rated EMRs.
-VISTA: If you think CPRS is bad just wait until you have to go into what is essentially the "boot" menu from a 1992 windows brick. Half of the time you have to type in some boot codes (which are usually posted somewhere on the wall) to get to certain lists (printable lists, consult lists, etc). they have not thought that doing what most at least half-brained organizations have done (you know, make it where you do not have to enter a boot menu to print something or find a certain consult list) is worth the time and money. To make matters worse, images are piled into a giant log of slow-to-boot garbage window that you hope someone labeled correctly so you can find it (im looking at you rads, echos, ecgs).
-remote access: Probably on par with some of the crappier hospital systems remote portals. The worst part though is having to have a card reader to log in. As if a password isn't enough. Probably some sort of government wide issue, but have they not heard of dual authentication, you know, something most video games online have had for a decade, and pretty much any bank worth the four dollars in your account has. We also have to log in every 45 days since if we don't we essentially have to call the equivalent to the VA white house to regain access, which can take up to a government minute (several weeks).
-no phone app: I would never work at a hospital without a phone app for the EMR, period.
-parking: The parking lots at the VA seemed to have been designed by someone who got drunk and was told to draw a modern art masterpiece. Plenty of open space but they seem to place the lots in the most inconvenient places (aka a mile away), and parking during the day is nonexistent. Even with a physician sticker, finding parking anytime after 8 am equates to parking near time square in NY.
-the Cafe: I am probably the least picky eater in the world but somehow they must have found the worst contracting company for food. I've worked at rinky dink rural hospitals in the middle of nowhere with better (and safer) food options. I'm not sure if they are trying to mimic the soup lines of the great depression, but if they are, hats off to the VA.
-Call rooms: I think there is one for the entire hospital, which fortunately we do not take 24 hour call at this place but some residencies do. They are essentially expected to IDK sleep in a chair? I honestly do not even know where it is, but I have heard it is in the least accessible part of the hospital away from any patients that you could call "acute". But they have stacks of 900 dollar chairs all over our VA (I looked into how much they cost) but they cant get residents a damn bed. Pathetic.
-staff: as with most places staff are hit or miss but its probably impossible to get fired from this place unless you lop someone's head off (even then its questionable). Some of the most clueless nurses (and probably doctors also, actually yes I can think of a few who might have 2 functioning brain cells) work here. I think they have increased pay to attract better staff but you could probably sleep all day in an empty bed and get a slap on the wrist if you are an employee here.
-amount of staff: I have literally no idea what half the people actually do at the VA besides collect a check and sit in a chair. They have plenty of articles online about this so I digress. From what I have read the VA does not even know how many physicians work for them (they cant keep track of contractors????).
- the CLC: I think our CLC has three physicians that work there. Each have like the = to 12 nursing home patients, AKA, I have no idea why you need three doctors for like 36 or so patients. They either do nothing all day or somehow turn writing 2 notes per day into an 8 hour endeavor.
- the buildings: Most of the building space isn't even used. May as well throw efficiency out the door.
- notes: The VA seems to think the solution is to make a note for EVERYTHING. MRI note, anticoagulation, note, note note, multiple procedure notes for one simple procedure, act of congress note to give a blood product.
-delegation: The amount of garbage providers have to do here greatly outweighs private hospitals. Ever try starting Eliquis on someone? 15 minute note. MRI note? yep, you have to do it not the MRI tech (WOW! LOL). transfer a patient? get ready for some carpel tunnel syndrome. Emergency orders? Nope, you have to wait 15 minutes for your card to work on a computer you have never used to put the order in.
I have a few other things but that was enough for one post. Again, this is all about working/training at the VA, not patient care related.
Well congratulations -- almost done!! It sounds like your program went very well and was very worthwhile. After reading through various posts on this topic, at least it seems your clinic is well put together and has a very well-run program.
I will definitely be applying to a few VA residencies w/ the hope of getting into one of them. Of course, I'll also consider regular positions, but I like how these residencies do the various rotations and you seem to get one on one time with the preceptor to guide you. That's golden!!
Just curious, how soon after you heard you got this position did you go out and find an apartment/place to live? Do most of these residencies give you some time so at least you might be able to fly in and check the general area? Did anybody give you recommendations as to safe areas? I'm a little nervous applying to places across the US from where I live, but if it gives me a chance for a residency, I'll do it.
For example, the incoming cohort was contacted of their acceptance into the program this past week and they are set to begin Mon 25 Sep. I believe half are moving from out of state, so they have a little over two months to find a place in Gainesville. No one gave recommendations on safe areas to live, but just do your research, of course.
Just a caveat. It hasn't been all rainbows and pony rides. We had our ups and downs with some of the rotations. They weren't perfect and we gave our director recommendations to enhance the experience for the incoming cohort. She heard us and made some changes. I think it'll improve with each cohort.
Just go for it. One of the incoming residents is moving to FL from a midwest state with her spouse and kids! It's a great opportunity. Getting a job in the VA is highly desirable. Our director told us there was one NP position that received over 3,000 applications! The pay is not like the private sector, but the work/life balance is a whole lot better. In primary care, patients per day are capped at 12-13(?) for a provider. We get all the Federal holidays off. The Veterans are such a great group to serve. I feel honored and lucky.
Well, my peeps, the third interview came and went. The primary care director did not offer me a position. I must say, it was disappointing to say the least. It was a two months long, three interviews, and driving 6 hours roundtrip twice ordeal that ended in a no. The CBOC I was hoping to work at was all MDs, so maybe that had something to do with it or I just don't have enough experience. Who knows these things. I finish the program in two months with no job. I'm applying to private practices and crossing fingers I get hired to work by October. I have a family to support and bills to pay. I hope everyone else is doing better than me.
You bring up a very valid point! Never thought of it that way - getting cheaper labor for a year. Although, there is still time commitment and time away for the preceptors, who have to standby and still be responsible for what you're doing and help train you along the way. This also takes away time from them seeing patients.
I'm glad you were able to acquire jobs to choose from afterward. I suppose, if you ever are looking for employment at the VA in the future, it can't be a bad thing you participated in a residency there and actually finished.
For people who might be reading this, and might want to take a shot at a job at the VA while in residency, would you recommend they start applying around the midway point then? It seems the hiring process takes a long time from what I have seen in this post and in others about the VA.
Yes, they should start applying as soon as possible. Some seem to think that as soon as we are in the system, you can be transferred to a job if you are hired. It's not that easy at my location, per the MD that was going to hired me. During orientation they asked how long it took to get a job at the VA and most replies were 9 months- 2 years.
Okay, this post is from a training standpoint, not a patient, or admin standpoint. The OP's post was revolving around residency at the VA so we will stick to this.
- onboarding: The amount of mostly pointless online (and unfortunately) in person training required for the VA is much higher than that of the private sector. Each year we have to do a bunch of modules which are mostly "duh" in quality. The first time onboarding we had to do CPRS training which was essentially an 8 hour session where someone "walks" us through online how to do things. Keep in mind we couldn't actually access CPRS for this training, you know "learn by doing" which pretty much every study shows is the best way to learn most things. Contrast to epic or cerner training where you do it in person or at least can access it via remote access.
- CPRS: This was probably a good system like 20 years ago, but for 2022 (really 2023) it is utter garbage. Is it the worst EMR? Maybe not, but it tries to be. No search function, no autocorrect, hard to read text, can be very slow for something that looks like it was made on a super nintendo. There is no recent patient list, difficult to read "flagging" of results, and don't get me started on the alerts. The system seems to think EVERYTHING needs to be sent to a mandatory "alert" box that you have to click and address. Some VAs have templates built in, but you may as well copy paste something from a word doc since they are slow, with tiny boxes, and often LAG like dial up did back in the 90s. Essentially have to have two monitors to write notes since you cannot really split screen things like you can on most highly rated EMRs.
-VISTA: If you think CPRS is bad just wait until you have to go into what is essentially the "boot" menu from a 1992 windows brick. Half of the time you have to type in some boot codes (which are usually posted somewhere on the wall) to get to certain lists (printable lists, consult lists, etc). they have not thought that doing what most at least half-brained organizations have done (you know, make it where you do not have to enter a boot menu to print something or find a certain consult list) is worth the time and money. To make matters worse, images are piled into a giant log of slow-to-boot garbage window that you hope someone labeled correctly so you can find it (im looking at you rads, echos, ecgs).
-remote access: Probably on par with some of the crappier hospital systems remote portals. The worst part though is having to have a card reader to log in. As if a password isn't enough. Probably some sort of government wide issue, but have they not heard of dual authentication, you know, something most video games online have had for a decade, and pretty much any bank worth the four dollars in your account has. We also have to log in every 45 days since if we don't we essentially have to call the equivalent to the VA white house to regain access, which can take up to a government minute (several weeks).
-no phone app: I would never work at a hospital without a phone app for the EMR, period.
-parking: The parking lots at the VA seemed to have been designed by someone who got drunk and was told to draw a modern art masterpiece. Plenty of open space but they seem to place the lots in the most inconvenient places (aka a mile away), and parking during the day is nonexistent. Even with a physician sticker, finding parking anytime after 8 am equates to parking near time square in NY.
-the Cafe: I am probably the least picky eater in the world but somehow they must have found the worst contracting company for food. I've worked at rinky dink rural hospitals in the middle of nowhere with better (and safer) food options. I'm not sure if they are trying to mimic the soup lines of the great depression, but if they are, hats off to the VA.
-Call rooms: I think there is one for the entire hospital, which fortunately we do not take 24 hour call at this place but some residencies do. They are essentially expected to IDK sleep in a chair? I honestly do not even know where it is, but I have heard it is in the least accessible part of the hospital away from any patients that you could call "acute". But they have stacks of 900 dollar chairs all over our VA (I looked into how much they cost) but they cant get residents a damn bed. Pathetic.
-staff: as with most places staff are hit or miss but its probably impossible to get fired from this place unless you lop someone's head off (even then its questionable). Some of the most clueless nurses (and probably doctors also, actually yes I can think of a few who might have 2 functioning brain cells) work here. I think they have increased pay to attract better staff but you could probably sleep all day in an empty bed and get a slap on the wrist if you are an employee here.
-amount of staff: I have literally no idea what half the people actually do at the VA besides collect a check and sit in a chair. They have plenty of articles online about this so I digress. From what I have read the VA does not even know how many physicians work for them (they cant keep track of contractors????).
- the CLC: I think our CLC has three physicians that work there. Each have like the = to 12 nursing home patients, AKA, I have no idea why you need three doctors for like 36 or so patients. They either do nothing all day or somehow turn writing 2 notes per day into an 8 hour endeavor.
- the buildings: Most of the building space isn't even used. May as well throw efficiency out the door.
- notes: The VA seems to think the solution is to make a note for EVERYTHING. MRI note, anticoagulation, note, note note, multiple procedure notes for one simple procedure, act of congress note to give a blood product.
-delegation: The amount of garbage providers have to do here greatly outweighs private hospitals. Ever try starting Eliquis on someone? 15 minute note. MRI note? yep, you have to do it not the MRI tech (WOW! LOL). transfer a patient? get ready for some carpel tunnel syndrome. Emergency orders? Nope, you have to wait 15 minutes for your card to work on a computer you have never used to put the order in.
I have a few other things but that was enough for one post. Again, this is all about working/training at the VA, not patient care related.
This answer made me LOL - I think I've become numb to the disparities that have been mentioned here. That being said, I will say the pay is competitive for APRNs in my area. The VA is actually paying more than most offers I've received (starting 124K/year plus all those great benefits!). Everyone that I've worked with from cardiologists to oncologists have been extremely eager to teach and distinguished medical professionals.
PATIENCE. You will need a lot of patience to work here. Most things are an act of congress, and making it through the onboarding process is a marathon in which you run in circles for half the time. But, I've found the work to be rewarding and my colleagues are supportive. For example, each primary care team has a Psychiatrist staffed on the unit that you can warm hand-off patients to after your appointment. I've had patients that are having terrible days and I'm able to message their mental health counselor during the PCP appointment to come see the patient after the appointment - and they're more than happy to do so. Specialists are just a teams message away for helping with unfamiliar diagnoses/test results.
So in short, yes the VA has its antiquated pitfalls. But if you can get past those things its not any more terrible than working out in the private sector and battling for-profit, evil insurance companies. And definitely bring your own lunch ?
Has anyone withdrawn from the residency program in the past? I'm trying to understand what options are available in case personal or professional circumstances change during the program.
I completed in 09/2023. I could've had a job, but returned back home to my family. The residency was 2.5 hrs away.
My love is dermatology and let me tell you that without experience or someone willing to train you, it's darn near impossible to find a job. However, the same VA I completed my residency opened two positions in derm, where I happened to spend a one month rotation in and they know me. I applied back in 11/2024 and just received an email for an interview.
I know things are bit up in the air these days, but if I am offered one of the positions, I'm taking it.
My geriatric primary care program was new and wasnt set up for success. We basically has to beg to go to other areas. We got none of what we were promised. I get it about the looking outside the VA.
Tegridy
583 Posts
LOL we have to do CLC for two weeks during our medical residency and all I can say is I’ve never been somewhere where they can turn a list of 12 nursing home patients into a full days worth of work.